Best of 2024 #1 - Arthritis: More Complicated than You May Think

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Alicia, 60, is an avid hiker but lately, her knees and hips bother her on the hills. Sometimes, her painful left hip wakes her up at night.

Emily, 47, has sore, swollen fingers that make it hard to use the computer. She worries she may have to stop working.

Craig, 58, wakes up in the middle of the night with excruciating pain in his big toe. It hurts so much, he’s had to call in sick and work from home.

What do Alicia, Emily, and Craig have in common? If you guessed arthritis, you’re only partly right. They do all have some type of arthritis, but the key word here is "type." In medical terms, arthritis means inflammation of the joints. That broad description encompasses more than 100 different medical conditions whose prevalence, cause, severity, and treatment vary greatly.

Osteoarthritis (OA)

Alicia has the most common type of arthritis, osteoarthritis, which affects 32.5 million American adults. OA is caused by damage to joint cartilage due to overuse, injury, and wear and tear over time. In osteoarthritis the cartilage that cushions the ends of the joints breaks down and wears away, causing swelling, pain, stiffness, and mobility issues. Over time, some people may be unable to work or even perform daily tasks due to reduced function.

Risk Factors for OA

• Age. While the risk of developing osteoarthritis increases with age, young people are not immune – according to the CDC, more than 8 million people between the ages of 18 and 44 have been diagnosed with arthritis, often resulting from sports injuries.
• Sex. Women are more likely to develop OA than men.
• Joint injury or overuse. This can affect anybody, but is often seen in athletes, weekend-warriors, or those with jobs that require repetitive movements, such as grocery clerks.
• Excess weight, which puts more stress on weight-bearing joints like the hips and knees.
• A family history of OA.

Treatment for OA

People with OA can be treated by their regular doctor. In advanced cases, they may want to consult an orthopedist about possible surgery. Because OA is due to physical damage, there is no cure. Doctors may recommend:

• Over-the-counter pain relievers such as ibuprofen or prescription drugs
• Physical therapy
• Increased physical activity (specifically low impact exercise such as swimming, biking, or walking)
• Losing weight if appropriate to help relieve stress on joints
• Supportive devices such as crutches or canes
• Joint replacement surgery

Rheumatoid Arthritis (RA)

Emily has Rheumatoid Arthritis, an autoimmune disorder that affects some 1.3 million Americans. Autoimmune disorders are conditions in which the immune system attacks healthy cells in the body, causing inflammation and other complications. Like OA, RA affects the joints, resulting in pain, stiffness, and mobility issues that may eventually lead to disability. However, whereas OA involves damage to protective cartilage, RA is caused by inflammation of the synovial membrane that protects and lubricates the joints. RA also differs from OA in these important ways:

• Roughly 40% of people with RA develop symptoms that affect the lungs, eyes, heart, and/or other parts of the body
• Whereas OA will often start on one side of the body, say the left knee or right hip, RA symptoms are bilateral
• In addition to joint pain, stiffness, tenderness, and/or swelling, RA sufferers may experience weakness, weight loss, fatigue, or fever
• RA alternates periods of increased severity, called flares, with periods of remission
• RA sufferers may develop balance issues, as well as deformities in the affected joints

Risk Factors for RA

• Age. RA can begin at any age, but the chance of developing it increases over time.
• Sex. Women are two to three times more likely to develop RA than men.
• Smoking. Not only do smokers have a higher risk of developing RA, but the habit can actually intensify symptoms.
• Excess weight. A history of obesity may increase both your risk and the ability to treat RA effectively.
• Genetics. The American College of Rheumatology (ACR) states that you can inherit a susceptibility to RA, but not the disease itself.
• Gum disease. In addition to being a risk factor for lung and heart disease, gum disease is now known as a risk factor for RA. The harmful bacteria that cause gingivitis and oral cancer can also spread to your lungs and cause inflammation, which in turn can spread to your joints.
• Childhood trauma. Emotional distress is a known trigger for the immune response that can lead to autoimmune disease such as RA, and increasingly those with a childhood history of violence, abuse or neglect are found to have a higher rate of RA as an adult.

Treatment for RA

People with RA should be seen by a rheumatologist – a specialist in diseases of the joints, muscles, and bones. RA is a chronic condition that can’t be cured, but effective treatment could relieve symptoms.

• Medication. NSAIDs (non-steroidal anti-inflammatory agents) have long been the first line of medication for RA patients. Today, corticosteroids and disease modifying anti-rheumatic drugs (DMARDs) are widely used to suppress the immune system, which slows disease progression and prevents joint deformity. In recent years, significant strides have been made in developing effective treatments that can help prevent permanent disability and more effectively manage symptoms.
• Self-management strategies can help people with RA stay as active and pain-free as possible.
• Occupational and physical therapy can help you maintain strength and independence for everyday activities.
• Surgical options. In certain situations, surgical options may be appropriate when other treatments no longer work.

Gout

Craig's painful big toe is a classic symptom of gout, a form of arthritis that affects one joint at a time. Like RA, gout has flareups and periods of remission, but it is not an autoimmune disease. It is caused by hypouricemia, an excess of uric acid in the body. The acid can form crystals that build up, notably in that troublesome big toe, and the affected joint becomes hot, swollen, and painful. People with gout also tend to develop kidney stones and hard uric acid deposits under the skin, called tophi.

Risk Factors for Gout

• Being male. Men are four times more likely to have gout than women.
• Excess weight
• Other health conditions such as metabolic syndrome, diabetes, insulin resistance, high blood pressure, congestive heart failure, and kidney disease increase the risk of gout.
• Taking diuretics and certain other medications.
• Drinking alcohol
• Consuming a lot of fructose, a sugar found in soda and candy.
• A diet high in purines, which the body breaks down into uric acid. Purines are found in red eat, organ meats, shellfish, trout, tuna, and sardines.

Treatment for Gout

Gout requires treatment by a rheumatologist. Treatment involves:

• Pain management during a flair up, through the use of NSAIDs such as ibuprofen, or acetaminophen, an anti-inflammatory medication called colchicine, and sometimes, corticosteroids.
• Preventing future flares through dietary changes and avoiding the use of alcohol.
• Drugs. Medications can help prevent uric acid production or help your kidneys improve its removal.

Other Types of Arthritis

Most types of arthritis are autoimmune conditions, all of which are best treated by a rheumatologist. The types listed below are some of the more common.

• Lupus is a chronic autoimmune disorder that mostly affects women (men account for just 4-18% of cases). Lupus causes inflammation and damage in joints, tendons, and organs. Flair ups can be triggered by infections, certain medications, and excess exposure to sunlight, which can trigger a characteristic butterfly-shaped rash on the face.
• Scleroderma, which means "hard skin", is an autoimmune disease that causes thickening of the skin and the connective tissue that binds the joints, muscles, blood vessels and internal organs.
• Ankylosing spondylitis causes fusing in the bones of the spine and inflammation in other parts of the body such as the neck, shoulders, hips, ribs, hands, and feet. Symptoms usually appear between the ages of 15 and 45.
• Juvenile rheumatoid arthritis (JRA) causes inflammation and joint stiffness in children. Children often outgrow JRA, but it can lead to growth irregularities that result in deformities.
• Psoriatic arthritis develops in about a third of people who have the autoimmune skin condition, psoriasis. Most people who develop psoriatic arthritis have had psoriasis, which causes red, scaly patches on the skin, for years. Psoriatic arthritis affects the joints, ligaments, and tendons.

Learn more about arthritis treatments at El Camino Health.

This article appeared in the March 2024 edition of the HealthPerks newsletter.